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ORIGINAL RESEARCH article
Front. Surg.
Sec. Thoracic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1589149
Improving Quality Outcomes Via Process Improvements and Innovation: 1,701 Consecutive Robotic Lobectomy and Segmentectomy, Largest Single Surgeon Series
Provisionally accepted- Langone Medical Center, New York University, New York City, New York, United States
Objectives: Our goal is to continuously improve patient quality outcomes and their care and experience.Methods: A quality improvement study from a single surgeon. This is the world’s largest reported consecutive series from one single surgeon of robotic lobectomy and segmentectomy.Results: From January 1, 2009 to December 31, 2024, there were 1,701 patients (52% women) of which 1,138 underwent robotic lobectomy (1,094, 96.1% were completed robotically) and 563 patients underwent segmentectomy (561, 99.6% were completed robotically). Quality metrics improved over each quartile: conversion rates decreased from 13 patients in our first 62 operations to 1 in our last 600 patients (p<0.001), 90-day mortality decreased from 0.3% to 0% (p<0.001), and major morbidity decreased from 6% to 1% (p<0.001). Patients with cancer underwent an R0 resection in 99%, had a median of five N2 and two N1 lymph node stations resected, 24 lymph nodes removed and blood loss of 20 cc. Efficiency metrics improved with medians of: length of stay decreased from 110 hours to 26 hours (p<0.001), operative times fell from 125 to 93 minutes (p<0.001), chest tube duration decreased from 72 hours to 4 hours, and patient satisfaction scores improved from 87% to 98%. Various selective process improvements and strategies that we implemented and, in our opinion, improved both patient outcomes and experience are shared in order to scale this experience to others.Conclusions: A commitment to getting better via innovation and process improvements of all aspects of the pre-, intra- and post-operative care and their pathways leads to improved outcomes and patient experience for robotic pulmonary resection. The selective processes and strategies that we believe led to these improving outcomes are shared and are possibly scalable elsewhere.
Keywords: robotic, Lobectomy, segmentectomy, Quality Improvement, Process implementation and change, robotic surgery
Received: 07 Mar 2025; Accepted: 07 Apr 2025.
Copyright: © 2025 Cerfolio, Ostro and McCormack. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Robert James Cerfolio, Langone Medical Center, New York University, New York City, 10016, New York, United States
Ashley J McCormack, Langone Medical Center, New York University, New York City, 10016, New York, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.